The COVID-19 pandemic, etiologically related to a new coronavirus, has had a catastrophic impact on the demographic situation on a global scale. The aim of this study was to analyze the manifestations of the COVID-19 epidemic process, the dynamics of circulation, and the rate of the spread of new variants of the SARS-CoV-2 virus in the Russian Federation. Retrospective epidemiological analysis of COVID-19 incidence from March 2020 to fall 2023 and molecular genetic monitoring of virus variability using next-generation sequencing technologies and bioinformatics methods were performed. Two phases of the pandemic, differing in the effectiveness of anti-epidemic measures and the evolution of the biological properties of the pathogen, were identified. Regularities of SARS-CoV-2 spread were determined, and risk territories (megacities), risk groups, and factors influencing the development of the epidemic process were identified. It was found that with each subsequent cycle of disease incidence rise, the pathogenicity of SARS-CoV-2 decreased against the background of the increasing infectiousness of SARS-CoV-2. Data on the mutational variability of the new coronavirus were obtained using the Russian platform of viral genomic information aggregation (VGARus) deployed at the Central Research Institute of Epidemiology. Monitoring the circulation of SARS-CoV-2 variants in Russia revealed the dominance of Delta and Omicron variants at different stages of the pandemic. Data from molecular genetic studies are an essential component of epidemiologic surveillance for making management decisions to prevent the further spread of SARS-CoV-2 and allow for prompt adaptation to pandemic control tactics.